Journal

PMG Conference 2019

The International Centre, Telford
15th - 17th July 2019

The Comprehensive Textbook of Clinical Biomechanics by Jim Richards

Review by Daniel Adams

Rehabilitation Engineer

12 November 2018

The Comprehensive Textbook of Clinical Biomechanics will be most relevant to those working in gait analysis. However, many healthcare professionals working in the field of posture and mobility, such as physiotherapists and rehabilitation engineers, will find sections of interest.

The book is split into three parts, each then further split into sub-sections, making it simple to flick through for reference to a particular topic.

1) Mechanics and Biomechanics Theory

This may be useful to newly qualified clinicians and engineers as an introduction to biomechanical theories and anatomy, although of greater benefit to those starting out in gait analysis. The section describes key terminology in detail, and how different forces can affect the human body and joint motion.

Although few sub-sections directly discuss the biomechanics of sitting, some of the information is still applicable to posture management. For example, there is a paragraph describing a person’s centre of mass, and how this changes with positioning, altering the impact of gravity on posture (sub-section 2.2.2). As this section is theory based, it contains many calculations and techniques which can be quite in-depth at times, so would be a helpful section to refer back to when needed.

2) Methods of Measurement and Modelling

This section is tailored to gait analysis and describes force platforms, camera and marker set up, and how to analyse the results. It discusses the differences between simple marker sets, using only a few cameras, and more complex sets, using eight or more cameras, plus the risk of misinterpreting the data due to the simultaneous movement of joints in multiple planes of the body. There is an informative sub-section on the strengths and weaknesses of different methods of movement analysis, and what to be aware of when interpreting the data collected. This also has a sub-section on electromyography and how to process the data in various ways, again describing factors to be aware of which may affect the data collected.

3) Clinical Assessment

This section is about what to consider when assessing lower limb tasks, such as stair ascent, describing the findings and how to critically evaluate these findings. It states that the majority of research literature in this area is based on walking, and stresses that movement patterns during different functional tasks is equally important to the patient’s quality of life. A section on orthotic management describes how and why insoles - AFO (ankle foot orthoses), and KAFO (knee ankle foot orthoses) - can help improve lower limb function. It includes a few examples of data from case studies, which help explain the theories by describing them in practice.

All sections describe theories and techniques to find the data required, how to interpret the data, and what may affect the results and corrupt any data. There are many graphical and anatomical illustrations to supplement the text, which are helpful to those not necessarily working in gait analysis.

I work predominantly with wheelchairs and postural management, and I found some of the sub-sections particularly relevant to my role, such as 1.4 Motion and Joint Motion, describing movements of the foot and knee joints and how forces affect all three sections of the foot, something to consider when distributing pressure evenly during positioning of the feet.

Another section of particular interest is 11.2 Sitting to Standing. It describes the demands on the upper and lower limbs, and the increased loads placed on the body if someone has restricted trunk movement or hamstring length. It also details the increased load and trunk movement velocity required when there is incorrect product sizing relative to the user’s body dimensions. It emphasises that equipment must be appropriate to ensure that functional tasks, such as standing transfers, are not compromised, so that the effort required is not excessive.

Though the focus of the book is gait analysis, there are themes that cross over into postural management. I would have liked more case studies to help understand the theories presented, but I still feel it would be a useful reference resource for many health departments.

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